1. Kickbusch London 2006 Ottawa – challenges we face Ilona Kickbusch Open University London 2006

2. Kickbusch London 2006 20 Years Ottawa Charter Towards a new public health……………………..

3. Kickbusch London 2006 Towards a new public health… We are challenged to develop a public health approach that responds to the globalized world and its political, social and economic ramifications. The challenge is as large as when public health was first developed.

4. Kickbusch London 2006 Better population health depends on: Making health everybody's business Ensuring equity. Making the healthy choice the easier choice Ensuring sustainability.

5. Kickbusch London 2006 Expansion processes of the health society the expansion of the do-ability of health: something can be done, there is always more health the expansion of the territory of health into an increasing array of personal, social and political spaces: health is everywhere the expansion of risk and reflexivity: every choice is potentially also a choice for or against health

6. Kickbusch London 2006 In almost every aspect of our lives we are faced with questions and decisions about health. Navigating the health society

7. Kickbusch London 2006 But…… UK: One in five people has problems with the basic skills needed to understand simple information that could lead to better health, 15% of adult population have low health literacy Canada: 22% of Canadians are unable to read a medicine label and calculate amounts of medicine US Institute of Medicine: 90 MILLION AMERICANS (NEARLY 1 IN 2 ADULTS) DO NOT UNDERSTAND BASIC HEALTH INFORMATION

8. Kickbusch London 2006 How to create health Health is created in the context of everyday life: where people live, love, work and play. Ottawa Charter 1986 Google?shop?travel? googlegoogle gogo

9. Kickbusch London 2006 The new public health: Health is created in the context of everyday life: where people live, love, work and play. Ottawa Charter Key components of change:

10. Kickbusch London 2006 1. Health and longevity drive society We need to adapt health and welfare Policies to achieve the „longevity dividend“

11. Kickbusch London 2006 2. Consumer society: Health as a global market force Commercialization and Privatization: health as a product Health as a key global market Countries compete on health

12. Kickbusch London 2006 Increasing number of consumer products and choices

13. Kickbusch London 2006 Increasing sources of health information

14. Kickbusch London 2006 Increasing choices in products and treatments

15. Kickbusch London 2006 Increasing provider choices

16. Kickbusch London 2006 Empowerment in the consumer society Citizens have a right to health competencies, patient competencies, consumer competencies, citizen competencies in the context of supportive environments Health Literacy is a critical empowerment strategy to increase people‘s control over their health, their ability to seekout information and their ability to take responsibility. Kickbusch/Maag 2005

17. Kickbusch London 2006 3. The globalizaton of everyday life drives health The global Risks in the 21 st century are transnational and all attempts to control them lead into the international arena The local Global risk production is localized through the “ globalization ” of everyday life COGNITIVE SPATIAL TEMPORAL

18. Kickbusch London 2006 Address the trans boundary scapes of health in a global world IdeoscapesImages with political ideological meanings TechnoscapesExport of technologies EthnoscapesFlow of people MediascapesMass media IT marketing FinanscapesGlobal capital transfers A. Appadurai, New School University, New York

19. Kickbusch London 2006 Healthscapes: Food - Drink

20. Kickbusch London 2006 Healthscape: virtual realities "The Internet is unlike anything we've seen before," says David Greenfield, PhD, founder of the Center for Internet Studies (www.virtual- addiction.com). "It's a socially connecting device that's socially isolating at the same time."www.virtual- addiction.com

21. Kickbusch London 2006 Healthscape Fashion industry New Regulations in Madrid: A model of 1,76 m. must not weigh less than 56 Kilogramm. That is a Body-Mass-Index of 18.0 and is already below the value assigned to a healthy body weight. Naomi Campbell 1,77 m. and weighs 51 Kilo. That means a BMI of 16.

22. Kickbusch London 2006 Healthscapes: women’s mobility Migration and increased mobility of women New slave markets Forced prostitution Domestic workers Health workers Low paid service work

23. Kickbusch London 2006 4. The policy arenas and actors shift Foreign policy Security policy Economic policy Trade policy Geopolitics From the ministries of health to:

24. Kickbusch London 2006 Consider the new health actors

25. Kickbusch London 2006 Consider the new health actors

26. Kickbusch London 2006 Consider the new health actors

27. Kickbusch London 2006 Consider the new health actors: Patient organizations

28. Kickbusch London 2006 Health policy becomes an „open system“ Health policy in the 21 st century is transnational and attempts to control risks by linking the local, national and the global policy arenas Health policy in the 21st century is part of all sectors and attempts to create health through new types of policy networks Healthy public policy

29. Kickbusch London 2006 Open systems of governance Finnish European Union Presidency Ideally: health agenda owned by other sectors Empowering ministries of health –Political will –Governance mechanisms

30. Kickbusch London 2006 Open systems of governance National global health strategies: “to counter from a national standpoint, the threats to global health” Problems which directly or indirectly threaten populations Contribution to global problems Contributions to global solutions National consensus on principles, values, intent and directions Foreign policy Security policy Economic policy Trade policy Demographic Geopolitics

31. Kickbusch London 2006 …..a new global POLITICAL ECOSYSTEM BONO CLINTON MSF 150 PPPH WEF PHA World Bank

32. Kickbusch London 2006 5. The Sustainability Challenge

33. Kickbusch London 2006 „ „Ecological footprint“ of the health system What amount of ressources does it take to create health?

34. Kickbusch London 2006 „Ecological footprint“ (2004 WHO) Costa RicaSchweizUSA GNP p.c.8 94934 08739 901 Life expectancy 757875 Health expectancy 657167 Health expenditure p.c. 616 (7,3%) 3776 (11,5%) 5711 (15,2%)

35. Kickbusch London 2006 The new dynamics of health We must begin not end with the political and social determinants of health Health is a determinant Health is an investment Health is a resource Health is a human right Health is a driving force in modern societies

36. Kickbusch London 2006 Political determinants….. The deliberation of major health issues and major health determinants in fora to which the public health community has little or no access – and is not prepared for. What kind of Ministers of Health??????????

37. Kickbusch London 2006 Political advocacy: Have you voted for health today? Public health actors must work systematically with political decision makers and parliamentarians at all levels of governance – national, European and global. Create new types of public health forums

38. Kickbusch London 2006 Health Promotion in a globalized world Healthy public policy Supportive environments Community action Personal skills Reorient health services Ottawa Charter health as a global public good a key component of collective human security a key factor of good global governance responsible business practice and social responsibility global citizenship and human rights.

39. Kickbusch London 2006 European nations should ensure through cooperation a common high level of health protection and health rights for all citizens wherever they live, love work and play (and travel, buy or google) from those risks and threats to their health, safety and well being which are beyond the control of individuals and communities AND NATION STATES And cannot be effectively tackled by nation states alone but need to be multiactor and multilevel ( e.g. health threats, unsafe products, unfair commercial practices ).

40. Kickbusch London 2006 The global is here not there.....

41. Kickbusch London 2006 Interdependence

42. Kickbusch London 2006 Global Governance becomes more important MOHMOH

43. Kickbusch London 2006 Regulatory power 1 The renewed mandate given to Member States and WHO under the IHR(2005) has also increased their respective roles and responsibilities. In particular, States Parties* to the IHR(2005) are required to develop, strengthen and maintain core surveillance and response capacities to detect, assess, notify and report public health events to WHO and respond to public health risks and public health emergencies. WHO, in turn, is to collaborate with States Parties to evaluate their public health capacities, facilitate technical cooperation, logistical support and the mobilization of financial resources for building capacity in surveillance and response. The broadened purpose and scope of the IHR(2005) are to "prevent, protect against, control and provide a public health response to the international spread of disease and which avoid unnecessary interference with international traffic and trade."

44. Kickbusch London 2006 Regulatory Power 2: Framework Convention Tobacco Control 27.05.2005 "The WHO FCTC negotiations have already unleashed a process that has resulted in visible differences at country level. The success of the WHO FCTC as a tool for public health will depend on the energy and political commitment that we devote to implementing it in countries in the coming years. A successful result will be global public health gains for all." Dr LEE Jong-wook. Director- General, World Health Organization 2006

45. Kickbusch London 2006 Framework Convention Tobacco Control

46. Kickbusch London 2006 Global developments: Projected prevalence of obesity in adults by 2025

47. Kickbusch London 2006 Local IMPACT Cost of the SARS epidemic to Toronto: 12 000 lost jobs Cost to the local economy: over $ 1 billion in 2003 Asia: Cost per person US$ 6 million (60 billion in costs)

48. Kickbusch London 2006 Accountability to “own” constituency and global community

49. Kickbusch London 2006 the tax on flights from France is expected to generate 200 million euros a year for an International Drug Purchase Facility, also known as Unitaid.The fund will be used to bulk-buy medicines for countries -- mainly in Africa – 19 pays se sont engagés à instaurer une contribution volontaire. 4 pays ont déjà rejoint la France en instaurant une contribution volontaire : le Chili, la Côte d’Ivoire, le Gabon, Maurice. 12 autres pays ont engagé des procédures interministérielles ou parlementaires pour l’adopter. Passengers flying out of French airports will pay one euro in economy class, and 10 euros in business, if their destination is in the EU. For flights outside Europe, the surcharges are between four and 40 euros, depending on the class Taxation

50. Kickbusch London 2006 Active health citizenship is a critical empowerment strategy in modern society – a significant dimension of citizen, consumer and patient’s rights and dignity –multi level dimensions Active citizenship

51. Kickbusch London 2006 „Une démarche citoyenne mondiale“